Since starting menopause about seven years ago, Sonja Warberg has endured hot flashes and night sweats as part of her daily life. Without any warning—whether she’s in court, spending time with friends, or even sleeping—her body heats up and she begins perspiring profusely. “On a stressful day, I might have eight to ten hot flashes during the day and several bouts throughout the night, when I wake up soaked in sweat,” Warberg says.

Warberg took Prempro, a drug containing the hormones estrogen and progestin used in hormone replacement therapy (HRT), to aid in battling her hot flashes, until she learned of the results of the 2002 Women’s Health Initiative study that showed the drug increases the risk of heart disease, breast cancer, and stroke. “When that study came out, I stopped taking Prempro immediately,” she says. Since then, Warberg’s hot flashes and night sweats have grown in frequency and intensity. She’s also experienced mood changes, including increased anxiety.

Sonja Warberg: What stage of menopause am I in, and when can I expect my menopausal symptoms to end?

Jane Guiltinan, ND: Menopause is defined as the moment when your last menstrual period ends. Perimenopause begins when the first symptoms of menopause appear, which does not mean the end of menses, because many changes can happen before your periods stop. Perimenopause continues until you are postmenopausal. And postmenopause begins 12 months after your last period ends. So you are officially postmenopausal, but you are still having menopausal symptoms.

Unfortunately, you are one of those women who have suffered for longer than average. Hot flashes and other menopausal symptoms can continue for up to ten years and, in rare cases, even longer. But generally most women don’t suffer from severe hot flashes for more than five years. Hopefully, even if your hot flashes continue for several more years, they will become less intense and less frequent. Q. What causes hot flashes and night sweats?

A. We are still not absolutely sure, but it appears that the decreasing estrogen levels associated with menopause have some sort of effect on the hypothalamus, an endocrine organ in the brain that helps regulate body temperature. So at random times, the body thinks it is too hot and, in response, its heat-loss mechanisms kick into gear. Blood vessels near the skin’s surface dilate to allow heat loss through the skin, and sweating begins to cool the body.

Q. I stopped taking Prempro after taking it for about five years. Do you think that was a smart move?

A. That is a complicated question, and the answer is very different in different situations. The Women’s Health Initiative research tells us that the risks associated with Prempro begin to increase significantly after you’ve taken the medicine for five years. So you were getting into the range where the risks outweighed the benefits. So, yes, I think it was the right decision for you to go off it.

Q. What are some alternative remedies that might help curtail my hot flashes and night sweats?

A. In terms of diet, reducing your intake of caffeine, alcohol, and spicy foods can help to reduce the incidence of hot flashes. Increasing your intake of foods that contain phytoestrogens can also reduce the frequency and severity of hot flashes. Soy contains the highest amount of phytoestrogens. Oats, almonds, flaxseeds, and lentils all have small amounts, too.

A good European study showed how exercise can help reduce hot flashes. In the study, the researchers compared groups of women who were having hot flashes. One group did 30 minutes of aerobic exercise three times a week and the other group did not. The group that exercised saw a 17 percent decrease in the severity and frequency of their hot flashes compared with the group that did not exercise.

Q. What are some natural supplements that might help?

A. Research supports the use of black cohosh (Cimicifuga racemosa) to reduce hot flashes, though the evidence is not as strong as it is for the use of conventional hormones. In studies, 40 mg of a standardized extract of black cohosh was taken twice a day. I suggest that you try this consistently for two months to see if it works for you. When using this and other supplements, it’s important that you get a high-quality supplement, you use the appropriate dose, and you do it consistently.

Other herbs have traditionally been used in naturopathic medicine to treat hot flashes; however, most of these have little, if any, research behind them. These include chaste tree (Vitex agnus-castus), licorice (Glycyrrhiza glabra and G. uralensis), and the Chinese herb dong quai (Angelica sinensis). Some studies on red clover (Trifolium pratense) extract have shown that it helps treat hot flashes, though other studies have not been conclusive. I find that vitamin E helps about 30 percent to 50 percent of my patients. Over-the-counter topical creams that contain either estrogen or progesterone have also helped ease hot flashes. Consult a health care provider to determine which cream to use.

Q. Since starting menopause, I feel as if my anxiety levels have increased. What are some natural remedies for this?

A. Menopause can trigger many mood changes, including anxiety. Kava (Piper methysticum) has some great research behind it for treating postmenopausal anxiety. But if you have liver disease or are taking any medications that can cause liver toxicity, you shouldn’t take kava. Speak to your health care practitioner about dosage.

Q. Would it be beneficial for me to see a naturopathic physician before starting a supplement regimen?

A. Absolutely. This will help to ensure you get high-quality supplements, are taking the right dose, and have someone who can monitor your health. For instance, if you were to start taking licorice, you would want to have your blood pressure monitored because licorice can cause hypertension, as well as water retention.